During initial conversations with surgeons, however, Walker learned many of the robotically trained physicians weren’t happy. Limited access to robots was preventing them from delivering equitable care to their community and serving patients in ways they believed would achieve superior patient outcomes.
Tony Guerra, FACHE, who was then the hospital’s CFO, spoke with Walker about giving physicians more robotic access. Guerra quickly realized that he needed to reevaluate the organization’s financial picture around robotic surgery. Understandably, previous executives had been wary of adding more robots, as, up until that time, capital purchasing was used exclusively to finance robotic assets. Guerra and his team decided to take a fresh look at alternative financing options.
“We realized there were advantages to the flexible acquisitions model,” says Guerra, who is now chief finance/market growth officer for Sharp Metropolitan Campus. “You get protection when it comes to technology obsolescence, service and maintenance.”
With a new approach to financing in 2020, Walker was given the go-ahead from system leadership to strategically grow the entire health system’s robotic service line. Following are keys to success.
Purposeful Alignment
For Sharp HealthCare, its mission to become one of the strongest robotic programs in the country required a strategic alignment among executive, operational and clinical leaders. It also needed commitment from all three areas to grow the robotic program in support of the health system’s vision: to be the best place to work, practice medicine and receive care.
This collaboration allows each area to better understand the others’ needs and perspectives, says Kathleen Kracht, RN, CNS, CNOR, director, Surgical Services, Sharp Memorial Hospital and James S. Brown Pavilion, Sharp HealthCare.
“If your operational team just sees a robotic program as added costs, then they’re not really aligned with the physicians to make sure that we are training appropriately. And if your executive team is just looking at straight dollars from a capital purchase perspective, then it is a giant barrier,” she says. “When you have open communication about what the needs are for each area, then you quickly realize, ‘wow, this could be beneficial for everybody.’”
The health system underscores this alignment via robotics committees at each hospital, where members discuss local performance issues and ideas regarding quality and efficiency. A systemwide executive steering committee, which incorporates executive, operations and clinical leaders from hospitals across the system, meets every other month.
One of the steering committee’s goals was to become a Network of Excellence in Robotic Surgery, a designation the health system earned from the Surgical Review Corporation in 2023, making it the first health system in California to do so. Five of its hospitals are now designated as Centers of Excellence, and 30 of its surgeons have achieved the Surgeons of Excellence in Robotic Surgery designation.
A Commitment to Health Equity
The aligned leadership structure and increased robotic competence among surgeons has helped support Sharp HealthCare’s organizationwide commitment to health equity.
“Because of the alignment with administration and with operations, we now have a 24/7 robotic program,” says Pamela Lee, MD, FACS, FASCRS, chair, Department of Surgery, Sharp Memorial Hospital/Sharp Rees Stealy Medical Group. “If we want to do a case at 9 p.m. or at midnight, if it’s an emergency, we have the staff to do it. Many organizations shut robots down at 4 p.m. because they haven’t trained after-hours staff to support the cases.”
To make 24/7 robotic access a reality, Sharp HealthCare leadership committed to making robotics a core competency for all staff, including nurses and techs, which provides flexibility for the team to cross-cover multiple areas, according to Walker. The organization can now serve more patients, including after hours and on weekends. This ensures patients have access to robotic surgery, whether it’s an elective case or an emergent case and no matter what type of insurance they have, Kracht says.
The Value of a 24/7 Robotic Program
Robotic Surgery—Modality of Choice Since 2018 (Percent of volume by modality 2014 to 2023)
A Culture of Positivity
Being able to provide robotic care 24/7 contributes to what the team at Sharp HealthCare emphasizes is a positive culture.
“Our doctors talk about it all the time,” Walker says. “They feel better; they feel like they’re delivering the same care to all patients without any discrimination.”
Alignment among executive and clinical leadership and clinicians themselves has resulted in greater physician satisfaction, according to Lee.
“I’ve worked at other institutions where there is an adversarial relationship between clinical staff and the administration, and it’s a recipe for clinician burnout,” she says. Sharp’s leadership, she says, “really cares about physician satisfaction” and makes clinicians feel heard.
The positive organizational culture and alignment combined with surgeon access to robots has also aided the organization’s ability to recruit and retain surgeons. Lee says multiple physicians in the organization have started working at Sharp because of access. And, due to the robotic surgical systems’ ergonomics, some senior-level physicians who haven’t performed robotic surgery are beginning to train on it, extending their careers and allowing their knowledge and mentorship of early careerists to remain in the organization for longer, according to Walker.
Data Drives It All Home
Data has been a key to growing and sustaining a strong robotic program at Sharp HealthCare, which now has 14 robotic assets, including the newest Da Vinci 5 model. Lee says she and the other surgeons benefit from data shared from Intuitive that reveals trends such as conversion rates from robotic to open surgery, which help drive performance improvement.
The data has also been beneficial in showing the robotic program’s value overall. For example, reduced length of stay resulting from the use of robotic surgery versus open surgery has saved the health system $25 million over five years. Since 2019, there has been a 16% ICU admission rate following robotic thoracic lobectomies versus an 81% chance of ICU admission following open and laparoscopic thoracic lobectomies.
Guerra points to situations in which the robotic approach per case is costlier than the strictly laparoscopic approach, and some service lines don’t necessarily perform as well financially on a per-case basis. “But when you look at the entire picture and take into account the reduced length of stay, complication and infection rates, patient post-operative pain and need for opiates for pain control, when you look at patient satisfaction and outcomes and surgeon and physician satisfaction, you truly can see the more value-based view of the entire program that we’ve created,” he says.
Written and published by ACHE
For more information, please contact Executive Education, Intuitive, at executive.education@intusurg.com.